Provider Demographics
NPI:1972686822
Name:BLAINE, DEBORAH J (MS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BLAINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:BLAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0959
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:
Practice Address - Street 1:1200 CHESTERLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7338
Practice Address - Country:US
Practice Address - Phone:509-575-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health